Page 1 of 27

DOE Review Release 07/06/2017

Rocky Flats Plant – Occupational Medical 

Dose

ORAUT-TKBS-0011-3 Rev. 02

Effective Date: 06/27/2017

Supersedes: Revision 01

Subject Expert(s): Brian P. Martin

Document Owner 

Approval: Signature on File

Mutty M. Sharfi, Document Owner

Approval Date: 06/23/2017

Concurrence: Signature on File

John M. Byrne, Objective 1 Manager

Concurrence Date: 06/22/2017

Concurrence: Signature on File

Scott R. Siebert, Objective 3 Manager

Concurrence Date: 06/23/2017

Concurrence: Signature on File

James P. Griffin, Deputy Project Director

Concurrence Date: 06/23/2017

Approval: Signature on File

James W. Neton, Associate Director for Science

Approval Date: 06/27/2017

FOR DOCUMENTS MARKED AS A TOTAL REWRITE, REVISION, OR PAGE CHANGE, REPLACE THE PRIOR 

REVISION AND DISCARD / DESTROY ALL COPIES OF THE PRIOR REVISION.

New Total Rewrite Revision Page Change
Document No. ORAUT-TKBS-0011-3 Revision No. 02 Effective Date: 06/27/2017 Page 2 of 27

PUBLICATION RECORD

EFFECTIVE 

DATE

REVISION 

NUMBER DESCRIPTION

02/09/2004 00 New Technical Basis Document for the Rocky Flats Plant –

Occupational Medical Dose. First approved issue. Initiated by 

Robert Meyer.

04/23/2007 01 Approved Revision 01 initiated to revise Table 3.4.2-2 (now Table 

3-6), text, and dose estimate tables to be consistent with ORAUTOTIB-0006 Rev 03 PC-1. Revised Table 3.2-1 (now Table 3-1) and 

text to specify the inclusion of termination X-rays for the period of 

1952-1986. Revised Table 3.4.1-2 (now Table 3-5) per commitment 

tracking form dated 02/06/2006. Revised to include attribution 

information per ORAU direction. The Worker Outreach comment 

from CT-0203 was addressed. Worker outreach comment from the 

June 23, 2004, meeting of the United Steelworkers of America Local 

8031 and Rocky Flats Security Officers Local Union 1 was addressed 

in Section 3.1. Incorporates formal internal and NIOSH review 

comments. Constitutes a total rewrite of document. This revision 

results in an increase in assigned dose and a PER is required. 

Training required: As determined by the Task Manager. Initiated by 

Robert Meyer.

06/27/2017 02 Revision initiated to update occupational medical X-ray doses for 

PFG, AP and LAT lumbar spine, and AP chest examinations. The 

AP chest examination dose update is specific to those performed 

starting June 11, 2001. Skin dose guidance and doses are also 

included in Attachment 1 of this revision based on information 

presented in ORAUT-OTIB-0006 Rev 04. Additional information 

regarding the availability of X-ray inventory sheets starting around 

February 2009 is included. CLL uncertainty parameters have been 

included as well. Updated Table A-2 to separate skin dose values for 

PA chest examinations between 1971 and 2001 into two time periods 

(1971-1984 and 1985-2001). Corrected transcription errors in Table 

A-1 of 8 skin doses for LAT exams performed prior through 1970 to 

correctly reflect values listed in ORAUT-OTIB-0006 Rev 04. 

Incorporates formal internal review comments. No changes occurred 

as a result of formal NIOSH review. Constitutes a total rewrite of the 

document. Training required: As determined by the Objective 

Manager. Initiated by Brian P. Martin.
Document No. ORAUT-TKBS-0011-3 Revision No. 02 Effective Date: 06/27/2017 Page 3 of 27

TABLE OF CONTENTS

SECTION TITLE PAGE

Acronyms and Abbreviations ............................................................................................................... 5

3.1 Introduction .............................................................................................................................. 7

3.1.1 Purpose........................................................................................................................ 8

3.1.2 Scope........................................................................................................................... 8

3.2 Background.............................................................................................................................. 8

3.3 Examination Frequency ........................................................................................................... 9

3.4 Equipment and Techniques...................................................................................................... 9

3.5 Organ Dose Estimates ........................................................................................................... 11

3.5.1 Parameters and Estimation Method............................................................................ 11

3.5.2 Organ Dose Estimates................................................................................................ 12

3.6 Uncertainties.......................................................................................................................... 14

3.7 Attributions and Annotations .................................................................................................. 18

References ........................................................................................................................................ 20

Glossary ............................................................................................................................................ 21

ATTACHMENT A SKIN VIEW GUIDANCE AND DOSE TABLES................................................ 23

LIST OF TABLES

TABLE TITLE PAGE

3-1 Default X-ray examination frequencies..................................................................................... 9

3-2 Description of X-ray equipment used at RFP and proxy information....................................... 10

3-3 Equipment settings and ratings .............................................................................................. 10

3-4 ICRP dose conversion factors; absorbed dose for organs at various Al HVL.......................... 13

3-5 Organs without ICRP publication 34 DCFs and their substitutes ............................................ 14

3-6 Organ dose estimates for PA chest........................................................................................ 16

3-7 Organ dose estimates for AP and LAT lumbar spine.............................................................. 17

3-8 Organ dose estimates for photofluorography, 1952 to 1968................................................... 17

3-9 IREP dose distributions and statistical parameters for the dose to the B lymphocytes ........... 18

A-1 Skin dose guidance and doses for examinations during poor collimation period, 1952 to 

1970.......................................................................................................................................24

A-2 Skin dose guidance and doses, 1971 to present.................................................................... 26
Document No. ORAUT-TKBS-0011-3 Revision No. 02 Effective Date: 06/27/2017 Page 4 of 27

LIST OF FIGURES

FIGURE TITLE PAGE

3-1 Kerma in air at 1 m from X-ray source as a function of total filtration for various values of 

tube potential .........................................................................................................................12
Document No. ORAUT-TKBS-0011-3 Revision No. 02 Effective Date: 06/27/2017 Page 5 of 27

ACRONYMS AND ABBREVIATIONS

AP anterior-posterior

AWE atomic weapons employer

cGy centigray

cm centimeter

DOE U.S. Department of Energy

DOL U.S. Department of Labor

EEOICPA Energy Employees Occupational Illness Compensation Program Act of 2000

ESE entrance skin exposure

Gy gray

HVL half-value layer

ICRP International Commission on Radiological Protection

in. inch

IREP Interactive RadioEpidemiological Program

keV kiloelectron-volt, 1,000 electron-volts

kV kilovolt

kVp kilovolts-peak

LAT lateral

m meter

mA milliampere

mAs milliampere-second

mGy milligray

mm millimeter

NIOSH National Institute for Occupational Safety and Health

ORAU Oak Ridge Associated Universities

PA posterior-anterior

PER program evaluation report

PFG photofluorography

R roentgen

RFP Rocky Flats Plant

s second

SEC Special Exposure Cohort

SID source-to-image distance

SRDB Ref ID Site Research Database Reference Identification (number)

SSD source-to-skin distance

Sv sievert

TBD technical basis document
Document No. ORAUT-TKBS-0011-3 Revision No. 02 Effective Date: 06/27/2017 Page 6 of 27

U.S.C. United States Code

§ section or sections
Document No. ORAUT-TKBS-0011-3 Revision No. 02 Effective Date: 06/27/2017 Page 7 of 27

3.1 INTRODUCTION

Technical basis documents and site profile documents are not official determinations made by the 

National Institute for Occupational Safety and Health (NIOSH) but are rather general working 

documents that provide historical background information and guidance to assist in the preparation of 

dose reconstructions at particular Department of Energy (DOE) or Atomic Weapons Employer (AWE) 

facilities or categories of DOE or AWE facilities. They will be revised in the event additional relevant 

information is obtained about the affected DOE or AWE facility(ies). These documents may be used 

to assist NIOSH staff in the evaluation of Special Exposure Cohort (SEC) petitions and the completion 

of the individual work required for each dose reconstruction.

In this document the word “facility” is used to refer to an area, building, or group of buildings that 

served a specific purpose at a DOE or AWE facility. It does not mean nor should it be equated to an 

“AWE facility” or a “DOE facility.” The terms AWE and DOE facility are defined in sections 7384l(5) 

and (12) of the Energy Employees Occupational Illness Compensation Program Act of 2000 

(EEOICPA), respectively. An AWE facility means “a facility, owned by an atomic weapons employer, 

that is or was used to process or produce, for use by the United States, material that emitted radiation 

and was used in the production of an atomic weapon, excluding uranium mining or milling.” 42 U.S.C. 

§ 7384l(5). On the other hand, a DOE facility is defined as “any building, structure, or premise, 

including the grounds upon which such building, structure, or premise is located ... in which 

operations are, or have been, conducted by, or on behalf of, the [DOE] (except for buildings, 

structures, premises, grounds, or operations ... pertaining to the Naval Nuclear Propulsion Program);” 

and with regard to which DOE has or had a proprietary interest, or “entered into a contract with an 

entity to provide management and operation, management and integration, environmental 

remediation services, construction, or maintenance services.” 42 U.S.C. § 7384l(12). The Department 

of Energy (DOE) determines whether a site meets the statutory definition of an AWE facility and the 

Department of Labor (DOL) determines if a site is a DOE facility and, if it is, designates it as such.

Accordingly, a Part B claim for benefits must be based on an energy employee’s eligible employment 

and occupational radiation exposure at a DOE or AWE facility during the facility’s designated time 

period and location (i.e., covered employee). After DOL determines that a claim meets the eligibility 

requirements under EEOICPA, DOL transmits the claim to NIOSH for a dose reconstruction. 

EEOICPA provides, among other things, guidance on eligible employment and the types of radiation 

exposure to be included in an individual dose reconstruction. Under EEOICPA, eligible employment 

at a DOE facility includes individuals who are or were employed by DOE and its predecessor 

agencies, as well as their contractors and subcontractors at the facility. Unlike the abovementioned 

statutory provisions on DOE facility definitions that contain specific descriptions or exclusions on 

facility designation, the statutory provision governing types of exposure to be included in dose 

reconstructions for DOE covered employees only requires that such exposures be incurred in the 

performance of duty. As such, NIOSH broadly construes radiation exposures incurred in the 

performance of duty to include all radiation exposures received as a condition of employment at 

covered DOE facilities in its dose reconstructions for covered employees. For covered employees at 

DOE facilities, individual dose reconstructions may also include radiation exposures related to the 

Naval Nuclear Propulsion Program at DOE facilities, if applicable. No efforts are made to determine 

the eligibility of any fraction of total measured exposure for inclusion in dose reconstruction.

NIOSH does not consider the following types of exposure as those incurred in the performance of 

duty as a condition of employment at a DOE facility. Therefore these exposures are not included in 

dose reconstructions for covered employees (NIOSH 2010):

• Background radiation, including radiation from naturally occurring radon present in 

conventional structures

• Radiation from X-rays received in the diagnosis of injuries or illnesses or for therapeutic 

reasons
Document No. ORAUT-TKBS-0011-3 Revision No. 02 Effective Date: 06/27/2017 Page 8 of 27

3.1.1 Purpose

This technical basis document (TBD) describes the methods for estimating absorbed dose from X-ray 

exposure for Rocky Flats Plant (RFP) workers. Where data are unavailable, assumptions have been 

made that are favorable to claimants [1]. 

3.1.2 Scope

Section 3.2 provides background. Section 3.3 describes X-ray examination frequency at RFP. 

Section 3.4 provides information on equipment and techniques used at RFP, including assumptions 

necessitated by lack of protocol, measurement, or records data. Section 3.5 provides organ dose 

estimates by calendar year and type of X-ray. Section 3.6 documents uncertainties. Attributions and 

annotations, indicated by bracketed callouts and used to identify the source, justification, or 

clarification of the associated information, are presented in Section 3.7.

3.2 BACKGROUND

As part of the requirements for employment at RFP, entrance, exit, and periodic physical 

examinations were performed on all employees. These physical examinations included radiographic 

examinations of the lungs and, for some employees, the lumbar spine [2]. Diagnostic medical X-rays 

administered in conjunction with routine or special physical examinations and required for 

employment are occupational exposures (NIOSH 2007). Only medical exposures that were required 

as a condition of employment are included; diagnostic and therapeutic procedures that were not 

required for employment are excluded (e.g., exposures that were received in the treatment of workrelated injuries).

As described in International Commission on Radiological Protection (ICRP) Publication 34, 

Protection of the Patient in Diagnostic Radiology, the amount of energy absorbed in the body and its 

distribution in specific organs can be determined by measurement or calculation (ICRP 1982). 

Absorbed dose in tissue, measured in units of gray, is equal to the energy absorbed per unit mass at 

a point in the human body. The quantity of radiation in terms of exposure from ionization of a specific 

mass of air by X-rays was in previous years measured in roentgens. The current International System 

of Units expresses this quantity in “air kerma” (kerma derives from kinetic energy released per unit 

mass). An exposure of 1 R corresponds to an air kerma of 8.7 mGy.

The radiation dose from a given examination varies widely throughout the body. Doses are highly 

dependent on the technical factors, characteristics of the equipment, collimation of the beam, and 

number of films taken. The general equation for total annual occupational medical dose from NIOSH 

guidelines is (NIOSH 2007):

om i D nD = ∑ (3-1)

where 

Dom = occupational medical dose

n = number of examinations in a calendar year

Di = dose from the X-ray procedure

The NIOSH guidelines state that medical records should contain the dates, types, and number of 

X-ray examinations, and that if no information is known about the energy spectra, values should 

conservatively be assumed to be in the 30- to 250-kV photon range, which is favorable to claimants. 

The guidelines also state that the uncertainty distribution about each X-ray procedure is assumed to 

follow a normal distribution, with Dom being the mean dose. 
Document No. ORAUT-TKBS-0011-3 Revision No. 02 Effective Date: 06/27/2017 Page 9 of 27

3.3 EXAMINATION FREQUENCY 

Beginning in February of 2009, the RFP records group committed to providing an X-ray “inventory” 

with new EEOICPA responses going forward. The RFP records group reviews documented films and 

provides a list of all X-ray examinations. Film records are provided in a spreadsheet which contains 

claimant name, NIOSH ID number, examination type, date of examination, and number of X-rays 

taken. X-ray records collected prior to February 2009 may be incomplete, including those 

summarized on 3x5 inch index cards and individual X-ray records. Dose reconstructors may request 

an X-ray inventory spreadsheet for claims prior to February 2009. The information presented below

may be used in the absence of claimant specific information.

The frequency of X-ray examinations varied significantly for RFP workers. Before approximately 

1986, many production workers received single-view chest X-rays on a nearly annual basis. (In a 

sample of medical records of production workers, no one was found to have consistently received 

annual chest X-rays due to occasional missed examinations and periods when examinations were 

apparently not provided on an annual basis [3].) Inspection of medical records has not revealed more 

specific designations of X-ray protocol by worker classification or job description [4]. Based on the 

records that were reviewed during preparation of this document, no worker received such 

examinations more often than annually [5]. Inclusion of termination chest X-rays is recommended for 

the period from 1952 to 1985 because they were common at other DOE sites and despite the fact that 

termination X-rays are believed by former medical workers to have been uncommon at RFP [6]. 

Table 3-1 lists frequency assumptions from 1952 through 1985.

Table 3-1. Default X-ray examination frequencies.

a

Period Frequency View Comment

1952–1968 Annual Chest (PFG) All workers

1952–1974 Once Lumbar (AP and LAT) All workers

1969–1985 Annual and termination Chest (PA) All workers

a. Default frequencies provide overestimating assumptions for the assignment of RFP occupational medical dose in the 

absence of a RFP X-ray inventory. 

Between 1952 and 1974, all workers received spinal X-rays during their initial employment (pre-hire) 

medical examination. This X-ray series consisted of a 14- by 17-in. AP view and a 10- by 12-in. 

lateral (LAT) view of the lumbosacral spine [7].

In the absence of a RFP provided X-ray film inventory or claim specific information, an approach to 

the estimation of the X-rays that is favorable to claimants is to assume lumbosacral spine X-rays were 

taken if the energy employee started work between 1952 and 1974. If an annual PFG examination 

(through 1968) or single-view chest X-ray is also assumed until 1974, this potential overestimation of 

X-ray use compensates for the few repeat radiographs that were taken because of the poor quality of 

the initial X-ray [8].

In the absence of a RFP provided X-ray inventory, it can be assumed that all personnel at RFP had 

an annual chest X-ray examination starting in 1969 (after removal of fluoroscope as discussed below). 

A protocol for frequency of a single posterior-anterior (PA) view chest X-ray as a function of job 

category was not fully established until approximately 1986 (Table 3-2). After that date, the frequency 

of routine chest X-rays varied widely depending on job description.

3.4 EQUIPMENT AND TECHNIQUES

Although RFP radiological practices are assumed to have followed standards of medical practice to 

minimize dose to the workers, the type of equipment, technique factors, and machine calibrations are 

not fully known for years before 2001. Members of the RFP TBD team interviewed medical and 

records group personnel and Colorado Department of Public Health and Environment personnel and 
Document No. ORAUT-TKBS-0011-3 Revision No. 02 Effective Date: 06/27/2017 Page 10 of 27

determined that X-ray machine records for equipment in use before 2001 are not readily available [9]. 

However, some information has been found in relation to equipment type and ratings; these data have 

been used in conjunction with default data where necessary to provide estimates of potential 

exposure that are favorable to claimants. Individual medical records should contain notations about 

dates and purposes of X-ray examinations, but reviews of medical records showed that this was not 

always the case before the mid-1970s [10]. 

Default X-ray organ dose estimates are provided for the periods before June 11, 2001, for which the 

equipment and techniques are unknown (ORAUT 2011). Organ dose estimates for occupational 

X-rays from June 11, 2001 to the present are provided in Table 3-7. The use of proxy data for the 

earlier periods is based on the belief that RFP, like other DOE sites, used the standard radiological 

procedures of the time. All assumptions were conservative (favorable to claimants). The default dose 

estimates are from the ORAUT-OTIB-0006, Dose Reconstruction from Occupational Medical X-ray 

Procedures (ORAUT 2011) for chest and lumbar spine X-rays. 

Photofluorography (PFG) exams were performed at RFP based on X-ray inventory records received 

with new EEOICPA responses after February 2009. Also, a note indicating that a fluoroscope was 

removed from the plant in 1968 indicating that fluoroscopy was performed (ORAUT 2003). Default

estimates of PFG exposure from ORAUT (2011) have been recommended in this TBD for the 

assignment of dose from PFGs. 

Efforts will continue to find related information for RFP. However, until more accurate records are 

found, these assumptions provide estimates for medical X-ray exposure that are favorable to 

claimants.

Tables 3-2 and 3-3 summarize known information about equipment and techniques.

Table 3-2. Description of X-ray equipment at RFP and proxy information. 

Period Classification Equipment Source

July 1953–August 30,1976 Type IV Keleket ORAUT 

2003

September 1, 1976–May 28, 

1987

Type III Generator unknown; Victoreen R Meter; BRH 

test stand; X-ray timer; aluminum filter set; light 

meter

ORAUT 

2003

May 29, 1987–March 6, 

2001

Type II Eureka XMA tube; Generator unknown ORAUT 

2003 [14]

June 11, 2001–present Type I Hologic/BXT202W ORAUT 

2003 [15]

Table 3-3. Equipment settings and ratings (ORAUT 2003). 

Period Machine View Current (mA) Voltage (kVp) Exposure time (s)

1952–1974 Type IV Lumbar APc 200 140 Unknown

1952–1974 Type IV Lumbar LATc 200 140 Unknown

7/1953–8/30/1976 Type IVb Chest PA 200 140 Unknown

9/01/1976–5/28/1987 Type IIIb Chest PA Unknown 80 Unknown

5/29/1987–3/6/2001 Type IIb Chest PA 360 130 Unknown

6/11/2001–present Type Ia Chest PA 300 110 0.003

a. Typical setting varied from 0.8 mAs for an average-sized person to 2.3 mAs for a very large person; 2.3 mA was used to 

be conservative.

b. Maximum machine ratings (ORAUT 2003); data not used to calculate doses, but are presented for informational 

purposes.

c. Performed only from 1952 to 1974 [13]; settings are maximum machine ratings (ORAUT 2003).
Document No. ORAUT-TKBS-0011-3 Revision No. 02 Effective Date: 06/27/2017 Page 11 of 27

3.5 ORGAN DOSE ESTIMATES

This section provides organ dose estimates. Section 3.5.1 describes the method used to estimate 

these doses, and Section 3.5.2 discusses the results. 

3.5.1 Parameters and Estimation Method

The ICRP (1982) guidance uses the following parameters to estimate air kerma and absorbed dose:

1. Source-to-image distance (SID) in centimeters,

2. Total filtration (millimeters of aluminum),

3. Estimate of person thickness for AP and LAT projections, and

4. Machine settings (mAs, kVp, film size, and single- or three-phase).

If measured air kerma data are available, these should be used. If not, air kerma rates can be 

estimated from Figure 3-1 (ICRP 1982) if average technique factors and total filtration are known.

Figure 3-1 is for single-phase machines; results should be multiplied by 1.8 for three-phase machines. 

The machine at RFP from June 11, 2001, is assumed to have been three-phase. Once the kerma 

rate is estimated, the air kerma at 100 cm is calculated by multiplying the estimated air kerma rate by 

the number of mAs for each radiograph (ICRP 1982).

Next, the source-to-skin distance (SSD) is calculated by subtracting the AP or LAT thickness of the 

standard (reference) worker or person and distance between the worker and the film (default distance 

of 5 cm) from the SID. Air kerma at the SSD is then estimated using the following equation:

2 air kerma at SSD SSD air kermaat1m (mGy) (100 ) = × (mGy) (3-2)

Tables A.2 through A.9 of ICRP (1982) are then used to estimate organ dose directly. Dose to the 

skin was estimated by multiplying the air kerma at SSD by the appropriate factor from Table B-8 of 

National Council of Radiation Protection and Measurements Report 102 (NCRP 1989). The tables list 

organ doses in milligray normalized to an air kerma of 1 Gy in air at the skin, as a function of 

half-value layers (HVLs) in millimeters of aluminum. In addition, ICRP (1982, Appendix A) provides 

tables for estimating the HVL if it is not known. Table 3-4 lists all such values that were used in this 

TBD.

The ICRP tables that were used to estimate absorbed dose do not include all organs that have been 

identified in the Interactive RadioEpidemiological Program (IREP). For those organs that are included 

in the IREP, but are not specifically identified in the ICRP tables, the dose conversion coefficient that 

is anatomically closest to the IREP-specified organs can be used to estimate dose. For example, the 

factor for the lung can be applied to all other organs in the thoracic cavity, such as the esophagus and 

bone surface (ORAUT 2011). For abdominal organs (e.g., bladder and colon), the dose coefficient for 

ovaries should be used (ORAUT 2011). This approach should be either favorable to claimants or 

neutral. Table 3-5 provides analogs for IREP organs.

Dose estimates for PA chest X-rays and pre-hire AP and LAT lumbar spine X-rays are presented in 

Tables 3-6 and 3-7 for each organ in ICRP (1982). All dose estimates are default values as 

presented in ORAUT (2011) with the exception of those for June 11, 2001, to present, which are 

based on known machine settings (ORAUT 2003) and information such as HVL supplied by former 

medical workers (ORAUT 2006).
Document No. ORAUT-TKBS-0011-3 Revision No. 02 Effective Date: 06/27/2017 Page 12 of 27

Figure 3-1. Kerma in air at 1 m from X-ray 

source as a function of total filtration for various 

values of tube potential (from ICRP 1982). 

PFG was used at RFP, but no information about protocol has been found. Lacking information about 

PFG at RFP, default dose estimates have been used (ORAUT 2011).

3.5.2 Organ Dose Estimates

Table 3-6 lists default organ dose estimates from PA chest X-rays for each period. Table 3-7 lists the 

default organ dose estimates for AP and LAT lumbar spine X-rays (note that the values have been 

halved to account for two views; ORAUT 2011). Table 3-8 lists default PFG exposure from chest 

examinations (ORAUT 2011) to be used when evidence of PFG examinations are found for a specific 

claim. Skin dose views for RFP X-ray examinations prior to June 11, 2001 should be assigned based 

on those presented in ORAUT (2011). Skin dose views for RFP X-ray examinations from June 11, 

2001 and later were determined based on the guidance presented in ORAUT (2010) and are 

presented in Attachment 1. 

At this time, there is insufficient information to calculate site-specific organ doses for RFP. This is true 

specifically for chest X-rays before 2001, all lumbar spine X-rays, and all PFG examinations. The 
 

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2 Effective Date: 06/27/2017 Page 13 of 27

Table 3-4. ICRP dose conversion factors; absorbed dose (1 mGy) for organs at various Al HVL (1-Gy entrance air kerma in air without 

backscatter). Image size 35.6 by 43.2 cm (ORAUT 2011).

Organ

Chest PA 

(through 

1970)a,b 

2.5 mm Al HVL, 

SID = 183 cm, 

Chest PAa 

(1971 to 1985), 

2.5 mm Al HVL 

SID=183 cm, 

Chest PAa

(1985 to 

present), 

4 mm Al HVL, 

SID = 183 cm, 

Lumbar 

spine APc 

(through 1970), 

2 mm 

Al HVL

Lumbar 

spine LATc 

(through 1970), 

2 mm 

AL HVL

Lumbar 

spine AP,c 

1971-1974 

2 mm 

Al HVL

Lumbar 

spine LAT,c 

1971-1974 

2 mm 

AL HVL

Thyroid 174d 32 78 0.2 0.01 0.3 0.01

Eye/brain 32 32 78 0.2 0.01 0.3 0.01

Ovaries N/A 1 5.2 N/A N/A 216 47

Liver/gall 

bladder/spleen

451 451 674 160 31 216 47

Urinary bladder N/A 1 5.2 160 31 216 47

Colon/rectum N/A 1 5.2 160 31 216 47

Testes N/A 0.01 0.01 N/Ae N/A 4.2 0.8

Lungs (male) 419 419 628 62 10 79 14

Lungs (female) 451 451 674 62 10 79 14

Thymus 451 451 674 62 10 79 14

Esophagus 451 451 674 62 10 79 14

Stomach 451 451 674 160 31 216 47

Bone surfaces 451 451 674 160 31 216 47

Remainder 451 451 674 160 31 216 47

Breast 49 49 116 18f 9.5f N/A N/A

Uterus 

(embryo)

N/A 1.3 5.2 217 20 287 31

Bone marrow 

(male)

92 92 178 24 15 37 22

Bone marrow 

(female)

86 86 172 24 15 37 22

Skin Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable

a. Dose conversion factors from ICRP (1982, Tables A.2 through A.9), ORAUT (2011).

b. Assumes minimal collimation.

c. From ORAUT (2011).

d. Dose conversion factor for AP cervical spine corrected for depth by 0.2.

e. N/A = not applicable as reported in ORAUT (2011).

f. Organ dose values for the testes, ovaries, and lumbar spine reflect actual measurement per Lincoln and Gupton (1958). 

g. Dose conversion factors for lumbar spine examination not given in ICRP (1982). Values for the respective upper gastrointestinal examinations (i.e., AP and LAT) 

were used instead. 
Document No. ORAUT-TKBS-0011-3 Revision No. 02 Effective Date: 06/27/2017 Page 14 of 27

 

Table 3-5. Organs without ICRP publication 34 DCFs and 

their substitutes.

a

IREP Organ ICRP 34 Substitute DCF

Thymus, 

Esophagus

Lung

Stomach, 

Bone Surface, 

Liver/gall bladder/spleen, 

Remainder organs

Lung or ovary

Urinary bladder, 

Colon/rectum, prostate

Ovary

Eye/brain Thyroid

a. As presented in ORAUT (2011).

organ doses that are presented here will be revised if additional site-specific information is found that 

allows more refined calculation of organ doses.

3.6 UNCERTAINTIES

As stated in ORAUT (2011), “error” is defined as deviation from the correct, true, or conventionally 

accepted value of a quantity, and “uncertainty” is defined in terms of the potential range of a stated, 

measured, assumed, or otherwise determined value of a quantity. Error and uncertainty provide an 

indication of confidence in the dose estimates. Uncertainty, expressed in terms of a confidence level, 

is a more appropriate term than error, which implies that the actual value is known. Uncertainty, 

stated as a probability of falling within a stated range, includes precision and reproducibility of the 

measurement as well as accuracy (that is, how close the estimate comes to the actual value).

Although many factors can introduce uncertainty and error into X-ray dose estimates, five factors 

contribute the most: measurement error, variation in peak kilovoltage, variation in beam current, 

variation in exposure time, and SSD. Film speed, use of screens, or use of grids would not affect the 

beam output intensity. The lack of records for these measurements for most years at RFP introduces 

a large uncertainty into the dose estimates that cannot be readily quantified, although there is no 

apparent reason to believe that practices at RFP were different from those at other facilities or from 

recommended standards of the medical community at the time [14]. Therefore, use of default 

estimates and reliance on information from other DOE sites when site-specific information was 

unavailable is likely to closely approximate X-ray performance at RFP. The following estimates of 

uncertainty associated with X-ray exposure are from ORAUT (2011), which was relied upon for default 

information. Further, these same factors affect dose estimates of PFG X-rays; proxy default 

information for PFG is from ORAUT (2011) in the absence of useful records at RFP.

ORAUT (2011) reports that recorded X-ray doses largely derive from actual measurements of X-ray 

machine output with R-meters or similar ionization chamber devices. These typically had a reported 

uncertainty of ±2% for photon energies below 400 keV, if properly calibrated and used. Although 

newer machinery might have a smaller uncertainty, ±2% should be used to be conservative.

Variation in peak kilovoltage generally falls within ±5% of the machine setting. Beam intensity is 

approximately proportional to the 1.7 power of the kilovoltage, which results in an uncertainty of 

approximately 9% in relation to beam intensity for voltages between 110 and 120 kVp (ORAUT 2011). 

Variations in tube current are normal and generally small. As tube current drops, beam intensity also 

falls in direct proportion to the tube current. Large decreases in beam output would be readily 

detected and would indicate the need for machine maintenance or, as a temporary measure, an 

increase in the current or voltage to provide the necessary intensity for proper radiography. However, 
Document No. ORAUT-TKBS-0011-3 Revision No. 02 Effective Date: 06/27/2017 Page 15 of 27

 

there is no evidence that such a procedure was ever needed or applied at RFP. Consistent with 

ORAUT (2011), the variation in tube current is assumed to be approximately ±5%.

Exposure time can also significantly affect the dose from radiography (exposure times are a fraction of 

a second). Even a small variation in exposure time due to timer error can significantly change beam 

output. Because early X-ray machine timers are known to have been inaccurate, uncertainty in beam 

output due to timers is assumed to be ±25% (ORAUT 2011). Therefore, it is recommended that ±25% 

be applied for RFP estimates, particularly because site-specific exposure time was available only for 

the present machine.

SSD can contribute to variability because the entrance skin exposure is determined by this distance. 

Variations result from accuracy of positioning as well as worker size (thickness). As expressed in 

ORAUT (2011), this is generally thought to vary by no more than a few centimeters, with an upper 

limit of 7.5 cm (±10%). 
Document No. ORAUT-TKBS-0011-3 Revision No. 02 Effective Date: 06/27/2017 Page 16 of 27

Table 3-6. Organ dose estimates for PA chest. 

Through 1970, 

HVL = 2.5 mm Al. entrance kerma = 0.20 cGyb

Organ mGy rem

Thyroid 3.48E-01 3.48E-02

Eye/brain 6.40E-02 6.40E-03

Ovaries 2.50E-01c 2.50E-02c

Liver/gall bladder/spleen 9.02E-01 9.02E-02

Urinary bladder 2.50E-01c 2.50E-02c

Colon/rectum 2.50E-01c 2.50E-02c

Testes 5.00E-02c 5.00E-03c

Lungs (male) 8.38E-01 8.38E-02

Lungs (female) 9.02E-01 9.02E-02

Thymus 9.02E-01 9.02E-02

Esophagus 9.02E-01 9.02E-02

Stomach 9.02E-01 9.02E-02

Bone surfaces 9.02E-01 9.02E-02

Remainder 9.02E-01 9.02E-02

Female breast 9.80E-02 9.80E-03

Uterus 2.50E-01c 2.50E-02c

Bone marrow (male) 1.84E-01 1.84E-02

Bone marrow (female) 1.72E-01 1.72E-02

Skin 2.70E+00 2.70E-01

1971 to 1985, 

HVL = 2.5 mm Al, entrance kerma = 0.10 cGyb

Organ mGy rem

Thyroid 3.20E-02 3.20E-03

Eye/brain 3.20E-02 3.20E-03

Ovaries 1.00E-03 1.0E-04

Liver/gall bladder/spleen 4.51E-01 4.51E-02

Urinary bladder 1.00E-03 1.00E-04

Colon/rectum 1.00E-03 1.00E-04

Testes 1.00E-05 1.00E-06

Lungs (male) 4.19E-01 4.19E-02

Lungs (female) 4.51E-01 4.51E-02

Thymus 4.51E-01 4.51E-02

Esophagus 4.51E-01 4.51E-02

Stomach 4.51E-01 4.51E-02

Bone surfaces 4.51E-01 4.51E-02

Remainder 4.51E-01 4.51E-02

Female breast 4.90E-02 4.90E-03

Uterus 1.30E-03 1.30E-04

Bone marrow (male) 9.20E-02 9.20E-03

Bone marrow (female) 8.60E-02 8.60E-03

Skin 1.35E+00 1.35E-01

1985 to June 4, 2001, 

HVL = 4.0 mm Al, entrance kerma = 0.05 cGyb

Organ mGy rem

Thyroid 3.90E-02 3.90E-03

Eye/brain 3.90E-02 3.90E-03

Ovaries 2.60E-03 2.60E-04

Liver/gall bladder/spleen 3.37E-01 3.37E-02

Urinary bladder 2.60E-03 2.60E-04

Colon/rectum 2.60E-03 2.60E-04

Testes 5.00E-06 5.00E-07

Lungs (male) 3.14E-01 3.14E-02

Lungs (female) 3.37E-01 3.37E-02

Thymus 3.37E-01 3.37E-02

Esophagus 3.37E-01 3.37E-02

Stomach 3.37E-01 3.37E-02

Bone surfaces 3.37E-01 3.37E-02

Remainder 3.37E-01 3.37E-02

Female breast 5.80E-02 5.80E-03

Uterus 2.60E-03 2.60E-04

Bone marrow (male) 8.90E-02 8.90E-03

Bone marrow (female) 8.60E-02 8.60E-03

Skin 7.00E-01 7.00E-02

June 11, 2001, to present [15], 

HVL = 4.0 mm Al; air kerma at skin = 0.129 mGya

Organ mGy rem

Thyroid 1.01E-02 1.01E-03

Eye/brain 1.01E-02 1.01E-03

Ovaries 6.72E-04 6.72E-05

Liver/gall bladder/spleen 8.71E-02 8.71E-03

Urinary bladder 6.72E-04 6.72E-05

Colon/rectum 6.72E-04 6.72E-05

Testes 1.29E-06 1.29E-07

Lungs (male) 8.12E-02 8.12E-03

Lungs (female) 8.71E-02 8.71E-03

Thymus 8.71E-02 8.71E-03

Esophagus 8.71E-02 8.71E-03

Stomach 8.71E-02 8.71E-03

Bone surfaces 8.71E-02 8.71E-03

Remainder 8.71E-02 8.71E-03

Female breast 1.50E-02 1.50E-03

Uterus 6.72E-04 6.72E-05

Bone marrow (male) 2.30E-02 2.30E-03

Bone marrow (female) 2.22E-02 2.22E-03

Skin 1.84E-01 1.84E-02

a. HVL determined from former medical workers (ORAUT 2006); machine settings from a memorandum to file (ORAUT

2003).

b. As presented in ORAUT (2011).

c. Modified from Webster and Merrill (1957) as presented in ORAUT (2011).
Document No. ORAUT-TKBS-0011-3 Revision No. 02 Effective Date: 06/27/2017 Page 17 of 27

 

Table 3-7. Organ dose estimates for AP and LAT lumbar spine, 1952 to 1974.

Organ

AP lumbar spine 

1952–1974

Entrance kerma 

1.44 cGya

LAT lumbar spine

1952–1974

Entrance kerma 

3.79 cGya

AP lumbar spine

1971–1974

Entrance kerma

0.91 cGy

LAT lumbar spine

1971–1974

Entrance kerma

3.48 cGy

Thyroid 2.88E-04 3.79E-05 2.73E-04 3.48E-05

Eye/brain 2.88E-04 3.79E-05 2.73E-04 3.48E-05

Ovaries 5.60E-01b 7.10E-01b 1.97E-01 1.64E-01

Urinary bladder 2.30E-01 1.17E-01 1.97E-01 1.64E-01

Colon/rectum 2.30E-01 1.17E-01 1.97E-01 1.64E-01

Testes 2.70E-02b 5.60E-02b 3.82E-03 2.78E-03

Lung 8.93E-02 3.79E-02 7.19E-02 4.87E-02

Liver/gall 

bladder/spleen

2.30E-01 1.17E-01 1.97E-01 1.64E-01

Thymus 8.93E-02 3.79E-02 7.19E-02 4.87E-02

Esophagus 8.93E-02 3.79E-02 7.19E-02 4.87E-02

Stomach 2.30E-01 1.17E-01 1.97E-01 1.64E-01

Bone surfaces 2.30E-01 1.17E-01 1.97E-01 1.64E-01

Remainder 2.30E-01 1.17E-01 1.97E-01 1.64E-01

Female breasta 4.78E-03 7.58E-03 9.56E-04 2.07E-03

Uterus 3.12E-01 7.58E-02 2.61E-02 1.08E-01

Bone marrow 3.46E-02 5.69E-02 3.37E-02 7.66E-02

Skinc 1.90E+00 5.00E+00 1.23E+00 4.70E+00

a. As presented in ORAUT (2011)

b. Organ dose values for the testes and ovaries for lumbar spine reflect actual measurement reported in Lincoln and 

Gupton (1958).

c. Skin dose values include backscatter factor of 1.32 from NCRP (1989, Table B.8).

Table 3-8. Organ dose estimates for photofluorography, 1952 to 1968 (as 

presented in ORAUT 2011). Entrance kerma = 2.27 cGy; HVL = 2.5 mm Al; all 

estimates are for uncollimated beams. 

Organ View

Dose conversion factor,a

HVL 2.5 mm Al, 

uncollimated 

(mGy per Gy air kerma)

Organ dose,

uncollimated 

(rem) 

Thyroid PA 174 3.94E-01

Eye/brain PA 32 7.25E-02

Ovaries PA N/A 2.50E-02b

Liver/gall bladder PA 451 1.02E+00

Urinary bladder PA N/A 2.50E-02b

Colon/rectum PA N/A 2.50E-02b

Testes PA N/A 5.00E-03b

Lungs (male) PA 419 9.50E-01

Lungs (female) PA 451 1.02E+00

Thymus PA 451 1.02E+00

Esophagus PA 451 1.02E+00

Stomach PA 451 1.02E+00

Bone surfaces PA 451 1.02E+00

Remainder PA 451 1.02E+00

Breast PA 49 1.11E-01

Uterus PA N/A 2.50E-02c

Bone marrow (male) PA 92 2.09E-01

Bone marrow (female) PA 86 1.95E-01

Skinc PA N/A 3.06E+00

a. Dose conversion factors from, ICRP (1982, Tables A.2 through A.9).

b. Modified from Webster and Merrill (1957), as reported in ORAUT (2011). 

c. Assuming back scatter factor of 1.32. 
Document No. ORAUT-TKBS-0011-3 Revision No. 02 Effective Date: 06/27/2017 Page 18 of 27

 

Consistent with ORAUT (2011), the statistical root mean square was calculated to estimate total 

uncertainty (ORAUT 2011). The root mean square is the square root of the sum of the squares of the 

individual uncertainty values, and equals 28.9%. An estimate of 30% uncertainty is larger than the 

default NIOSH guidance standard deviation recommendation of 20% (NIOSH 2007). 

The tissue at risk for chronic lymphocytic leukemia is the B-lymphocytes. The dose to the Blymphocytes was determined using the method in ORAUT-RPRT-0064, Medical Dose to the BLymphocytes (ORAUT 2014), site-specific information, and ICRP Publication 34 DCFs (ICRP 1982). 

Table 3-9 provides dose distributions and statistical parameters for input into the Interactive 

RadioEpidemiological Program (IREP) for determining dose to the B-lymphocytes.

Table 3-9. IREP dose distributions and statistical parameters for the dose to the B-lymphocytes.

Projection Year Distribution Parameters 1, 2, and 3

PFG 1952–1968 Use OTIB-0006 PFG Use OTIB-0006 PFG

PA chest 1952–1970 Use OTIB-0006 through1970 Use OTIB-0006 through1970

AP LS 1952–1970 Use OTIB-0006 through1970 Use OTIB-0006 through1970

LAT LS 1952–1970 Use OTIB-0006 through 1970 Use OTIB-0006through 1970

AP LS 1971-1974 Use OTIB-0006 after 1970 Use OTIB-0006 after 1970 

LAT LS 1971-1974 Use OTIB-0006 after 1970 Use OTIB-0006 after 1970

PA chest 1971–1985 Use OTIB-0006 1971-1985 Use OTIB-0006 1971-1985

PA chest 1986–2001 Use OTIB-0006 1986–present Use OTIB-0006 1986–present

PA chest 2002–present Weibull3 2.124902, 0.003815, and –7.1779E-07

3.7 ATTRIBUTIONS AND ANNOTATIONS

Where appropriate in this document, bracketed callouts have been inserted to indicate information, 

conclusions, and recommendations provided to assist in the process of worker dose reconstruction. 

These callouts are listed here in the Attributions and Annotations section, with information to identify 

the source and justification for each associated item. Conventional References, which are provided in 

the next section of this document, link data, quotations, and other information to documents available 

for review on the Project’s Site Research Database (SRDB).

[1] Lopez, Theresa. Oak Ridge Associated Universities (ORAU) Team. Senior Toxicologist. July 

2006. 

In the absence of data or protocols, assumptions that needed to be made were favorable to 

claimants.

[2] Furman, J. ORAU Team. Former Medical Director, Rocky Flats Plant. July 2003. 

Based on work history at the site and available protocols. Documented July 18, 2003.

[3] Furman, J. ORAU Team. Former Medical Director, Rocky Flats Plant. July 2003.

Based on review of medical files at RFP. Documented July 18, 2003.

[4] Furman, J. ORAU Team. Former Medical Director, Rocky Flats Plant. July 2003.

Based on review of medical files at RFP. Documented July 18, 2003.

[5] Furman, J. ORAU Team. Former Medical Director, Rocky Flats Plant. July 2003.

Based on review of medical files at RFP. Documented July 18, 2003.

[6] Furman, J. ORAU Team. Former Medical Director, Rocky Flats Plant. July 2003.

Based on review of medical files at RFP and interviews with medical personnel. Documented 

July 18, 2003. 
Document No. ORAUT-TKBS-0011-3 Revision No. 02 Effective Date: 06/27/2017 Page 19 of 27

 

[7] Furman, J. ORAU Team. Former Medical Director, Rocky Flats Plant. July 2003.

Based on personal history of working at the site and medical file review. Documented July 18, 

2003.

[8] Lopez, Theresa. ORAU Team. Senior Toxicologist. July 2006. 

An annual single-view chest X-ray is likely an overestimate of actual practice because a review 

of medical files found that chest X-rays rarely occurred on an annual basis, probably due to 

scheduling and machine availability. However, this assumption is favorable to claimants 

because it encompasses more X-rays than were probably taken.

[9] Furman, J. ORAU Team. Former Medical Director, Rocky Flats Plant. July 2003.

Documented July 18, 2003. Also documented by Robert Meyer, August 13, 2003.

[10] Furman, J. ORAU Team. Former Medical Director, Rocky Flats Plant. July 2003.

Based on review of medical files and discussions. Documented July 18, 2003.

[11] Furman, J. ORAU Team. Former Medical Director, Rocky Flats Plant. July 2003.

Based on review of medical files and discussions. Documented July 18, 2003.

[12] Furman, J. ORAU Team. Former Medical Director, Rocky Flats Plant. July 2003.

Based on review of medical files and discussions. Documented July 18, 2003.

[13] Furman, J. ORAU Team. Former Medical Director, Rocky Flats Plant. July 2003.

Based on medical personnel interviews and review of medical files. Documented July 18, 

2003.

[14] Lopez, Theresa. ORAU Team. Senior Toxicologist. July 2006.

Calculated from information given to J. Furman by the Occupational Medicine Group at RFP. 

Documented July 18, 2003.

[15] Furman, J. ORAU Team. Former Medical Director, Rocky Flats Plant. July 2003.

Based on personal work history at the site.
Document No. ORAUT-TKBS-0011-3 Revision No. 02 Effective Date: 06/27/2017 Page 20 of 27

REFERENCES

EG&G (Edgerton, Germeshausen, and Grier), 1991, Occupational Health Medical Examination 

Criteria, Appendix I, Rocky Flats Plant, Golden, Colorado, November. [SRDB Ref ID: 71527]

ICRP (International Commission on Radiological Protection), 1982, Protection of the Patient in 

Diagnostic Radiology, Publication 34, Pergamon Press, Oxford, England. [SRDB Ref ID: 

32466]

Lincoln, T. A., and E. D. Gupton, 1958, “Radiation Doses in Diagnostic X-Ray Procedures,” 

Radiology, volume 71, pp. 208–215. [SRDB Ref ID: 11099]

NCRP (National Council of Radiation Protection and Measurements), 1989, Medical X-Ray, Electron 

Beam and Gamma-Ray Protection for Energies Up to 50 MeV (Equipment Design, 

Performance and Use), Report 102, Bethesda, Maryland, June 30. [SRDB Ref ID: 32467]

NIOSH (National Institute for Occupational Safety and Health), 2007, External Dose Reconstruction 

Implementation Guideline, OCAS-IG-001, Rev. 3, Office of Compensation Analysis and 

Support, Cincinnati, Ohio, November 21.

NIOSH (National Institute for Occupational Safety and Health), 2010, Radiation Exposures Covered 

for Dose Reconstructions Under Part B of the Energy Employees Occupational Illness 

Compensation Program Act, DCAS-IG-003, Rev. 1, Division of Compensation Analysis and 

Support, Cincinnati, Ohio, October 5.

ORAUT (Oak Ridge Associated Universities Team), 2003, “Regarding Location of Rocky Flats X-Ray 

Documents,” memorandum to file, Oak Ridge, Tennessee, October 21. [SRDB Ref ID: 

12408]

ORAUT (Oak Ridge Associated Universities Team), 2006, “2001 X-Ray Machine Settings for RFP,”

documented communication, Oak Ridge, Tennessee, August 2. [SRDB Ref ID: 25014]

ORAUT (Oak Ridge Associated Universities Team), 2010, Occupational Medical X-Ray Dose 

Reconstruction for DOE Sites, ORAUT-PROC-0061, Rev 03, Oak Ridge, Tennessee, March 3.

[SRDB Ref ID: 79758]

ORAUT (Oak Ridge Associated Universities Team), 2011, Dose Reconstruction from Occupational 

Medical X-Ray Procedures, ORAUT-OTIB-0006, Rev. 04, Oak Ridge, Tennessee, June 20.

ORAUT (Oak Ridge Associated Universities Team), 2014, Medical Dose to the B-Lymphocytes, 

ORAUT-RPRT-0064, Rev. 00, Oak Ridge, Tennessee, June 03.

Webster, E. W., and O. E. Merrill, 1957, “Measurements of Gonadal Dose in Radiographic 

Examinations,” New England Journal of Medicine, volume 257, pp. 811–819. [SRDB Ref ID: 

11100]
Document No. ORAUT-TKBS-0011-3 Revision No. 02 Effective Date: 06/27/2017 Page 21 of 27

GLOSSARY

air kerma in air

The sum of kinetic energy of all charged particles liberated per unit mass of air. The unit is the 

joule per kilogram and is given the special name gray.

exposure

In this document, measure of the ionization produced by X- and gamma-ray photons in air in 

units of roentgens.

gray (Gy)

International System unit of absorbed radiation dose, which is the amount of energy from any 

type of ionizing radiation deposited in any medium; 1 gray equals 1 joule per kilogram or 

100 rads.

kerma

Measure in units of absorbed dose (usually grays but sometimes rads) of the energy released 

by radiation from a given amount of a substance. Kerma is the sum of the initial kinetic 

energies of all the charged ionizing particles liberated by uncharged ionizing particles 

(neutrons and photons) per unit mass of a specified material. Free-in-air kerma refers to the 

amount of radiation at a location before adjustment for any external shielding from structures 

or terrain. The word derives from kinetic energy released per unit mass.

lumbosacral spine

Region of the spine including the five lumbar vertebrae (lower back) and the five fused sacral 

vertebrae (posterior wall of the pelvis).

radiation

Subatomic particles and electromagnetic rays (photons) with kinetic energy that interact with 

matter through various mechanisms that involve energy transfer.

rem

Traditional unit of radiation dose equivalent that indicates the biological damage caused by 

radiation equivalent to that caused by 1 rad of high-penetration X-rays multiplied by a quality 

factor. The sievert is the International System unit; 1 rem equals 0.01 sievert. The word 

derives from roentgen equivalent in man; rem is also the plural.

roentgen (R)

Unit of photon (gamma or X-ray) exposure for which the resultant ionization liberates a positive 

or negative charge equal to 2.58 × 10-4 coulombs per kilogram (or 1 electrostatic unit of 

electricity per cubic centimeter) of dry air at 0 degrees Celsius and standard atmospheric 

pressure. An exposure of 1 roentgen is approximately equivalent to an absorbed dose of 

1 rad in soft tissue for higher energy photons (generally greater than 100 kiloelectron-volts).

skin dose

See shallow dose equivalent.

sievert (Sv)

International System unit for dose equivalent, which indicates the biological damage caused 

by radiation. The unit is the radiation value in gray (equal to 1 joule per kilogram) multiplied by 

a weighting factor for the type of radiation and a weighting factor for the tissue; 1 sievert 

equals 100 rem.
Document No. ORAUT-TKBS-0011-3 Revision No. 02 Effective Date: 06/27/2017 Page 22 of 27

shallow dose equivalent

Dose equivalent in units of rem or sievert at a depth of 0.07 millimeters (7 milligrams per 

square centimeter) in tissue equal to the sum of the penetrating and nonpenetrating doses.

X-ray radiation

Electromagnetic radiation (photons) produced by bombardment of atoms by accelerated 

particles. X-rays are produced by various mechanisms including bremsstrahlung and electron 

shell transitions within atoms (characteristic X-rays). Once formed, there is no difference 

between X-rays and gamma rays, but gamma photons originate inside the nucleus of an atom.
Document No. ORAUT-TKBS-0011-3 Revision No. 02 Effective Date: 06/27/2017 Page 23 of 27

 

ATTACHMENT A 

SKIN VIEW GUIDANCE AND DOSE TABLES

LIST OF TABLES

TABLE TITLE PAGE

A-1 Skin dose guidance and doses for examinations during poor collimation period, 1952 to 

1970.......................................................................................................................................24

A-2 Skin dose guidance and doses, 1971 to present .................................................................... 26
ATTACHMENT A

SKIN VIEW GUIDANCE AND DOSE TABLES (continued)

Document No. ORAUT-TKBS-0011-3 Revision No. 02 Effective Date: 06/27/2017 Page 24 of 27

Table A-1. Skin dose guidance and doses for examinations during poor collimation period, 1952 to 1970.

Area of Skin

Basis for 

PFG 

1952–1968

PFG dose 

1952–1968

Basis for 

PA chest 

through 

1970

PA chest 

dose 

through 

1970

Basis for 

AP lumbar 

through 

1970

AP lumbar 

dose 

through 

1970

Basis for 

LAT lumbar 

through 

1970

LAT dose 

through 

1970

R front shoulder EXSD 6.67E-02 EXSD 5.9E-03 10% ENSD 1.90E-01 10% ENSD 5.00E-01

R back shoulder ENSD 3.06E+00 ENSD 2.70E-01 10% EXSD 3.60E-03 10% ENSD 5.00E-01

L front shoulder EXSD 6.67E-02 EXSD 5.9E-03 10% ENSD 1.90E-01 10% EXSD 1.90E-03

L back shoulder ENSD 3.06E+00 ENSD 2.70E-01 10% EXSD 3.60E-03 10% EXSD 1.90E-03

R upper arm to elbow 10% ENSD 3.06E-01 ENSD 2.70E-01 10% ENSD 1.90E-01 10% ENSD 5.00E-01

L upper arm to elbow 10% ENSD 3.06E-01 ENSD 2.70E-01 10% ENSD 1.90E-01 10% EXSD 1.90E-03

L hand ENSD 3.06E+00 ENSD 2.70E-01 ENSD 1.90E+00 10% EXSD 1.90E-03

R hand ENSD 3.06E+00 ENSD 2.70E-01 ENSD 1.90E+00 10% ENSD 5.00E-01

L elbow, forearm, wrist 10% ENSD 3.06E-01 ENSD 2.70E-01 ENSD 1.90E+00 10% EXSD 1.90E-03

R elbow, forearm, wrist 10% ENSD 3.06E-01 ENSD 2.70E-01 ENSD 1.90E+00 10% ENSD 5.00E-01

R side of head 

(including temple and 

ear)

10% ENSD 3.06E-01 10% ENSD 2.70E-02 Eye/brain 2.88E-04 Eye/brain 3.79E-05

L side of head 

(including temple and 

ear)

10% ENSD 3.06E-01 10% ENSD 2.70E-02 Eye/brain 2.88E-04 Eye/brain 3.79E-05

Front left thigh RSD (0.52m) 9.01E-04 RSD (0.52m) 8.E-05 10% ENSD 1.90E-01 10% EXSD 1.90E-03

Back left thigh RSD (0.52m) 9.01E-04 RSD (0.52m) 8.E-05 10% EXSD 3.60E-03 10% EXSD 1.90E-03

Front right thigh RSD (0.52m) 9.01E-04 RSD (0.52m) 8.E-05 10% ENSD 1.90E-01 10% ENSD 5.00E-01

Back right thigh RSD (0.52m) 9.01E-04 RSD (0.52m) 8.E-05 10% EXSD 3.60E-03 10% ENSD 5.00E-01

L knee and below RSD (0.86m) 9.01E-04 RSD (0.86m) 3.E-05 RSD (0.60m) 4.00E-04 RSD (0.60m) 5.00E-04

R knee and below RSD (0.86m) 9.01E-04 RSD (0.86m) 3.E-05 RSD (0.60m) 4.00E-04 RSD (0.60m) 5.00E-04

L side of face Eye/brain 7.25E-02 Eye/brain 6.4E-03 Eye/brain 3.00E-04 Eye/brain 3.00E-05

R side of face Eye/brain 7.25E-02 Eye/brain 6.4E-03 Eye/brain 3.00E-04 Eye/brain 3.00E-05

L side of neck 10% ENSD 3.06E-01 ENSD 2.70E-01 Eye/brain 3.00E-04 Eye/brain 3.00E-05

R side of neck 10% ENSD 3.06E-01 ENSD 2.70E-01 Eye/brain 3.00E-04 Eye/brain 3.00E-05

Back of head 10% ENSD 3.06E-01 10% ENSD 2.70E-02 Eye/brain 3.00E-04 Eye/brain 3.00E-05

Front of neck Eye/brain 7.25E-02 Eye/brain 6.4E-03 Eye/brain 3.00E-04 Eye/brain 3.00E-05

Back of neck 10% ENSD 3.06E-01 ENSD 2.70E-01 Eye/brain 3.00E-04 Eye/brain 3.00E-05

Front torso: base of 

neck to end of sternum

EXSD 6.67E-02 EXSD 5.9E-03 10% ENSD 1.90E-01 Lung 3.79E-02

Front torso: end of 

sternum to lowest rib

EXSD 6.67E-02 EXSD 5.9E-03 ENSD 1.90E+00 Lung 3.79E-02
ATTACHMENT A

SKIN VIEW GUIDANCE AND DOSE TABLES (continued)

Document No. ORAUT-TKBS-0011-3 Revision No. 02 Effective Date: 06/27/2017 Page 25 of 27

Area of Skin

Basis for 

PFG 

1952–1968

PFG dose 

1952–1968

Basis for 

PA chest 

through 

1970

PA chest 

dose 

through 

1970

Basis for 

AP lumbar 

through 

1970

AP lumbar 

dose 

through 

1970

Basis for 

LAT lumbar 

through 

1970

LAT dose 

through 

1970

Front torso: lowest rib 

to iliac crest

EXSD 6.67E-02 EXSD 5.9E-03 ENSD 1.90E+00 Lung 3.79E-02

Front torso: iliac crest 

to pubis

10% EXSD 6.67E-03 10% EXSD 6.E-04 ENSD 1.90E+00 Lung 3.79E-02

Back torso: base of 

neck to mid-back

ENSD 3.06E+00 ENSD 2.70E-01 10% EXSD 3.60E-03 Lung 3.79E-02

Back torso: mid-back 

to lowest rib

ENSD 3.06E+00 ENSD 2.70E-01 EXSD 3.64E-02 Lung 3.79E-02

Back torso: lowest rib 

to iliac crest

ENSD 3.06E+00 ENSD 2.70E-01 EXSD 3.64E-02 Lung 3.79E-02

Back torso: buttocks 

(Iliac crest and below)

10% ENSD 3.06E-01 10% ENSD 2.70E-02 EXSD 3.64E-02 Lung 3.79E-02

Right torso: base of 

neck to end of sternum

ENSD 3.06E+00 ENSD 2.70E-01 10% ENSD 1.90E-01 10% ENSD 5.00E-01

Right torso: end of 

sternum to lowest rib

ENSD 3.06E+00 ENSD 2.70E-01 ENSD 1.90E+00 ENSD 5.00E+00

Right torso: lowest rib 

to iliac crest

ENSD 3.06E+00 ENSD 2.70E-01 ENSD 1.90E+00 ENSD 5.00E+00

Right torso: iliac crest 

to pubis (R hip)

10% ENSD 3.06E-01 10% ENSD 2.70E-02 ENSD 1.90E+00 ENSD 5.00E+00

Left torso: base of 

neck to end of sternum

ENSD 3.06E+00 ENSD 2.70E-01 10% ENSD 1.90E-01 10% EXSD 1.90E-03

Left torso: end of 

sternum to lowest rib

ENSD 3.06E+00 ENSD 2.70E-01 ENSD 1.90E+00 EXSD 1.90E-02

Left torso: lowest rib to 

iliac crest

ENSD 3.06E+00 ENSD 2.70E-01 ENSD 1.90E+00 EXSD 1.90E-02

Left torso: iliac crest to 

pubis (L hip)

10% ENSD 3.06E-01 10% ENSD 2.70E-02 ENSD 1.90E+00 EXSD 1.90E-02
ATTACHMENT A

SKIN VIEW GUIDANCE AND DOSE TABLES (continued)

Document No. ORAUT-TKBS-0011-3 Revision No. 02 Effective Date: 06/27/2017 Page 26 of 27

Table A-2. Skin dose guidance and doses, 1971 to present. 

Area of Skin

Basis for 

AP lumbar 

1971–1974

AP lumbar 

dose 

1971–1974

Basis for 

LAT lumbar 

1971–1974

LAT lumbar 

dose 

1971–1974

Basis for 

PA chest 

1971–present

PA chest 

dose 

1971– 1984

PA chest 

dose 

1985-2001

PA chest 

dose 2002–

present

R front shoulder 10% ENSD 6.53E-02 10% ENSD 5.9E-03 EXSD 2.9E-03 2.87E-03 7.53E-04

R back shoulder 10% EXSD 3.00E+00 10% ENSD 2.70E-01 ENSD 1.35E-01 7.00E-02 1.84E-02

L front shoulder 10% ENSD 6.53E-02 10% EXSD 5.9E-03 EXSD 2.9E-03 2.87E-03 7.53E-04

L back shoulder 10% EXSD 3.00E+00 10% EXSD 2.70E-01 ENSD 1.35E-01 7.00E-02 1.84E-02

R upper arm to elbow 10% ENSD 3.00E-01 10% ENSD 2.70E-01 10% ENSD 1.35E-02 7.00E-03 1.84E-03

L upper arm to elbow 10% ENSD 3.00E-01 10% EXSD 2.70E-01 10% ENSD 1.35E-02 7.00E-03 1.84E-03

L hand 10% ENSD 3.00E+00 10% EXSD 2.70E-01 10% ENSD 1.35E-02 7.00E-03 1.84E-03

R hand 10% ENSD 3.00E+00 10% ENSD 2.70E-01 10% ENSD 1.35E-02 7.00E-03 1.84E-03

L elbow, forearm, wrist 10% ENSD 3.00E-01 10% EXSD 2.70E-01 10% ENSD 1.35E-02 7.00E-03 1.84E-03

R elbow, forearm, wrist 10% ENSD 3.00E-01 10% ENSD 2.70E-01 10% ENSD 1.35E-02 7.00E-03 1.84E-03

R side of head (including 

temple and ear)

Eye/brain 3.00E-01 Eye/brain 2.70E-02 10% ENSD 1.35E-02 7.00E-03 1.84E-03

L side of head (including 

temple and ear)

Eye/brain 3.00E-01 Eye/brain 2.70E-02 10% ENSD 1.35E-02 7.00E-03 1.84E-03

Front left thigh 10% ENSD 8.82E-04 10% EXSD 8.E-05 RSD (0.52m) 4.E-05 2.28E-05 6.00E-06

Back left thigh 10% EXSD 8.82E-04 10% EXSD 8.E-05 RSD (0.52m) 4.E-05 2.28E-05 6.00E-06

Front right thigh 10% ENSD 8.82E-04 10% ENSD 8.E-05 RSD (0.52m) 4.E-05 2.28E-05 6.00E-06

Back right thigh 10% EXSD 8.82E-04 10% ENSD 8.E-05 RSD (0.52m) 4.E-05 2.28E-05 6.00E-06

L knee and below RSD (0.60m) 8.82E-04 RSD (0.60m) 3.E-05 RSD (0.86m) 1.E-05 8.34E-06 3.71E-05

R knee and below RSD (0.60m) 8.82E-04 RSD (0.60m) 3.E-05 RSD (0.86m) 1.E-05 8.34E-06 3.71E-05

L side of face Eye/brain 7.25E-02 Eye/brain 6.4E-03 Eye/brain 3.2E-03 1.01E-03 1.01E-03

R side of face Eye/brain 7.25E-02 Eye/brain 6.4E-03 Eye/brain 3.2E-03 1.01E-03 1.01E-03

L side of neck Eye/brain 3.00E-01 Eye/brain 2.70E-01 10% ENSD 1.35E-02 7.00E-03 1.84E-03

R side of neck Eye/brain 3.00E-01 Eye/brain 2.70E-01 10% ENSD 1.35E-02 7.00E-03 1.84E-03

Back of head Eye/brain 3.00E-01 Eye/brain 2.70E-02 10% ENSD 1.35E-02 7.00E-03 1.84E-03

Front of neck Eye/brain 7.25E-02 Eye/brain 6.4E-03 Thyroid 3.2E-03 1.01E-03 1.01E-03

Back of neck Eye/brain 3.00E-01 Eye/brain 2.70E-01 10% ENSD 1.35E-02 7.00E-03 1.84E-03

Front torso: base of neck 

to end of sternum

10% ENSD 6.53E-02 Lung 5.9E-03 EXSD 2.9E-03 2.87E-03 7.53E-04

Front torso: end of 

sternum to lowest rib

ENSD 6.53E-02 Lung 5.9E-03 EXSD 2.9E-03 2.87E-03 7.53E-04

Front torso: lowest rib to 

iliac crest

ENSD 6.53E-02 Lung 5.9E-03 10% EXSD 3.E-04 2.87E-04 7.53E-05

Front torso: iliac crest to 

pubis

ENSD 6.53E-03 Lung 6.E-04 10% EXSD 3.E-04 2.87E-04 7.53E-05

Back torso: base of neck 

to mid-back

10% EXSD 3.00E+00 Lung 2.70E-01 ENSD 1.35E-01 7.00E-02 1.84E-02
ATTACHMENT A

SKIN VIEW GUIDANCE AND DOSE TABLES (continued)

Document No. ORAUT-TKBS-0011-3 Revision No. 02 Effective Date: 06/27/2017 Page 27 of 27

Area of Skin

Basis for 

AP lumbar 

1971–1974

AP lumbar 

dose 

1971–1974

Basis for 

LAT lumbar 

1971–1974

LAT lumbar 

dose 

1971–1974

Basis for 

PA chest 

1971–present

PA chest 

dose 

1971– 1984

PA chest 

dose 

1985-2001

PA chest 

dose 2002–

present

Back torso: mid-back to 

lowest rib

EXSD 3.00E+00 Lung 2.70E-01 ENSD 1.35E-01 7.00E-02 1.84E-02

Back torso: lowest rib to 

iliac crest

EXSD 3.00E+00 Lung 2.70E-01 10% ENSD 1.35E-02 7.00E-03 1.84E-03

Back torso: buttocks (Iliac 

crest and below)

EXSD 3.00E-01 Lung 2.70E-02 10% ENSD 1.35E-02 7.00E-03 1.84E-03

Right torso: base of neck 

to end of sternum

10% ENSD 3.00E+00 10% ENSD 2.70E-01 ENSD 1.35E-01 7.00E-02 1.84E-02

Right torso: end of 

sternum to lowest rib

ENSD 3.00E+00 ENSD 2.70E-01 ENSD 1.35E-01 7.00E-02 1.84E-02

Right torso: lowest rib to 

iliac crest

ENSD 3.00E+00 ENSD 2.70E-01 10% ENSD 1.35E-02 7.00E-03 1.84E-03

Right torso: iliac crest to 

pubis (R hip)

ENSD 3.00E-01 ENSD 2.70E-02 10% ENSD 1.35E-02 7.00E-03 1.84E-03

Left torso: base of neck 

to end of sternum

10% ENSD 3.00E+00 10% EXSD 2.70E-01 ENSD 1.35E-01 7.00E-02 1.84E-02

Left torso: end of 

sternum to lowest rib

ENSD 3.00E+00 EXSD 2.70E-01 ENSD 1.35E-01 7.00E-02 1.84E-02

Left torso: lowest rib to 

iliac crest

ENSD 3.00E+00 EXSD 2.70E-01 10% ENSD 1.35E-02 7.00E-03 1.84E-03

Left torso: iliac crest to 

pubis (L hip)

ENSD 3.00E-01 EXSD 2.70E-02 10% ENSD 1.35E-02 7.00E-03 1.84E-03